Angiograms obtained from 10 cases of hepatolithiasis were reviewed to know liver parenchymalchanges accompaning the disease. On arteriograms hypervascularity attributable to inflammationwas noted in 5 cases. The incidence of portal blood flow disturbance was well corelated with thatof bile duct deformity such as dilatation and/or stricture. When bile duct was not dilated theincidence of the flow disturbance in adjacent portal vein was 6.8%, however when dilatation ofthe ducts were moderate and marked the incidences were 50% and 86.4% respectively. In thegroups with absent, moderate and marked bile duct stricture, the incidences of portal blood flowdisturbance were 25.6, 66.7 and 100% respectively. Apparent hepatic lobar atrophy was notedin 7 cases. Marked shrinking or obstruction of portal vein within the lobe was found, howeverthe arterial blood flow was relatively well maintained.
The authors stressed that distubance of the regional portal blood flow is the inportant factoraffecting the hepatic and the biliary condition.

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In order to reveal the causes of bile duct dilatation, we attempted to make the models of canine dilated bile duct. Following four models which are claimed to produce bile duct dilatation are examined.
1) narrowing the lower common bile duct lumen by taping plastic tube
2) formalin injection into papillary mucosa
3) stripping common bile duct
4) sphincterotomy
Dilatation of common bile duct could be produced successfully in the first three groups and not in the last group which used sphincterotomy.
The severe bile stasis was observed by cholangiomanometry in group 1 and 2. The bile dilatation in these groups is considered to be caused by increase of intraductal pressure. In group 3, bile duct dilatation occured in spite of abscence of bile stenosis. Cholangiomanometry showed normal range for this group. Weakness of bile duct wall and surrounding tissues probably causes bile stasis.
From the above results, it is possible to divide the methods which experimentally produce bile duct dilatation into two groups. One method is to disturb biliary passage such as papillary stenosis or bile duct stenosis. Another one is to strip bile duct without any stenosis.

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Acute suppurative cholangitis continues to be fatal in cases of choledocholithiasis and in biliary tract malignancy. ERCP and ERS allows early detection and treatment of suppurative cholangitis and prevents its progression to multiple organ failure. We carried out ERCP in 8,146 cases in which 90 cases were diagnosed as acute cholangitis. The average age of patients was 68.1 years, most of them between 6 th and 8 th decade. The sex distribution was equal. Causes of ASC were as follows; choledocholithiasis in 68 cases (75.6%), malignancy of biliary tract in 18 cases (20.0%), miscellaneous in 4 cases (4,4%).
The emergency ES and removal of CBD stone was performed soon after confirmation of ASC. Satisfactory biliary drainage was obtained in 37.8% and stone extraction in 62.2%. The mortality rate was 3.3% (3/90) which suggested that endoscopic approach was better than conventional approaches reported earlier. The three patients who died had severe form of DIC. Early ERCP and ERS would prevent such complications.

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We have performed a clinicopathological study of the modes of spread of gallbladder carcinoma in 123 resected specimens. The frequency of major modes of spread were as follows, invasion to the liver 43%, invasion to the hepatoduodenal ligament 39%, invasion to other organs 29% and lymph node metastases 68%, respectively. When we analyzed the mode of invasion to the liver, we found out that when the site of invasion was at the liver bed, intrahepatic spread was relatively localized and expansive growth, whereas when the invasion was at the hepatic hilum, most of cases showed infiltrative spread deep in to the liver. Most of the invasion to the hepatoduodenal ligament were marked and there were high frequency of lymphatic, venous and perineural invasion with 70~97%. Main sites of lymph node metastases were,12 b 2,13 a,8 and 14 respectively. There was a correlation between the site of tumor and frequency of lymph node metastases among the cases in which the depth of infiltration was to the subserosa.

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Examining the effect of ADM, MMC and 5-FU on the Nozawa (Cultured Human Gallblader Cell lines) at the hyperthermic conditions, ADM treated group showed most prominent enhanced inhibitory effect to the Nozawa by the hyperthermic treatment.
Examining the effects of combined treatment of hyperthermia and anticancer drugs on the Nozawa cells by changing the incubation period, the ADM treated group showed prominent enhanced inhibitory effect by elonging the incubation period.
Examining the correlations between the CEA production and the cell viability by the combined treatment of hyperthermia and anticancer drugs, the CEA production showed no positive correlation with the cell viavility.
Hyperthermia decreased the cell viavility, however, it did not effect the CEA production.
The changes of therapeutic effects of anticancer drugs at the hyperthermic conditions observed in these results probably due to the differrences of pharmacological mechanism of action as well as the permeability of cell membrance.

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Primary lesions (mucous gland metaplasia, lymph-follicle formation, cholesterosis, formation of Rokitansky-Aschoff sinus, RAS) of the gallbladder were histologically studied to investigate the morphologic changes in the formation of gallstones.
As compared with the non-calculous gallbladder (control), the incidence of mucous gland metaplasia was significantly high in each calculous gallbladder. Lymph-follicle formation in the gallbladder with calcium bilirubinate stones and RAS formation in the gallbladder with cholesterol stones were characteristically and significantly high, respectively.
Regarding histologic scoring of each gallbladder recorded on the basis of the presence and severity of the lesions, each calculous gallbladder tended to have higher average score than the control, but did not significantly score highly.
In interrelation among primary lesions, relationship between the severity of mucous gland metaplasia and cholesterosis showed reverse correlation.
As a result, mucous gland metaplasia was the most common and characteristic morphologic change in the calculous gallbladder. It is suggested that mucous gland metaplasia in the gallbladder may play a part of role of the gallbladder in the formation of gallstones.

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On ordinary cholangiography, it is difficult to obtain well visualized cholangiogram of the caudate branches, because the majority of the caudate branches is located behind the hepatic hilum. Since July,1985, cholangiography in cephalad anterior oblique (CAO) position which is obtained by positioning the patient with body up or tilting the X-ray tube cephaladly was performed on eleven cases. Fine cholangiograms of the caudate branches were obtained by CAO position in all cases. CAO position was of value in identifying bile ducts of the caudate lobe and understanding their morphology.

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In order to clarify the pathophysiological findings of papillary function in cases of intrahepatic gallstones and extract their therapeutic implications, constituent classification of the intrahepatic gallstones collected during the past 10 years was carried out: group A consisting of type I calcium bilirubinate gallstones (8 cases); group B of type I E (15); group C of type I E, I E calcium bilirubinate gallstones (10) and group D of cholesterol stones and black stones (6).
Results in the cases of intrahepatic calcium bilirubinate gallstones indicated that contribution of bile stasis due to duodenal papillitis was probable to their stone formation, irrespective of their clinical patterns. In spite of their apparent complete lithotomy, adequate biliary drainage appeared indispensable in many cases. The sphincteroplasty seemed to be one of the most physiological drainage, but it must not be attempted on those patients in whom residual gallstones are probable. No doubt hepatectomy is one of the most reliable and plausible principles of complete lithotomy. In cases of bilateral intrahepatic gallstones, however, first we have to clear the stones in one lobe by PTCS, and then proceed to hepatectomy in the other.

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In cholelithiasis, T-tube anaplasty is indicated mainly as a preventive treatment to reduced pressure in biliary tract and residual stones after choledochotomy. Recently, it has offered problems of increased hospitalization and medical cost as well as serious complications such as tubedislocation and fistulasion insufficiency. We designed an improved technique, an extracorporeal guide by retrograde transhepatic route using 28 recent cases in order to resolve the problems of T-tube anaplasty peformed after choledochotomy ten years as one day. The present paper describes usefulness and clinical results of our technique laying stress on image diagnosis.

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A 51 year-old female with biliary ascariasis was reported. Suddenly she was complained of severe epigastralgia and back pain.
On admission, she had tenderness in her epigastric region. Liver, spleen and kidneys were not palpable. Laboratory data were within normal limit and ova of Ascaris were not found in her feces.
DIC showed a vague linear filling defect in the common bile duct. Further, it was confirmed as an obvious linear filling defect in the common bile duct, by the first ERCP. She was diagnosed as a biliary ascariasis and treated by an oral vermifuge (pyrantol pamoate 500mg).
After three days the second ERCP was done, but the previous linear filling defect was disappeared. Eight days after the oral vermifuge, adult Ascaris was found in her feces.

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A 64-year-old woman was admitted to our hospital complaining of general fatigue and weight-loss. Ultrasonography (US) and computed tomography (CT) demonstrated multiple papillary tumors in the highly delated intrahepatic bile duct. Endoscopic retrograde cholangiopancreatography (ERCP) with a balloon catheter was performed demonstrating a normal pancreatic duct but a delated intra- and extra bile duct. In addition a right hepatic duct was obstructed with tumors and multiple filling defects were seen in a left hepatic duct. US guided percutaneous transhepatic cholangiography (PTC) and aspiration cytology of right intrahepatic bile duct and tumors were carried out, and the diagnosis was classified into group 5. Therefore we thought a radical surgery was not applicable. The patient died of jaundice with cholangitis and hemorrage after 15 months. By autopsy it was proved to be multiple bile duct adenomas in both the left and right hepatic bile duct. And a papillo-tubular adenocarcinoma was present in the minimum part of the adenomas.

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Benign bile duct tumors are very rare. In Japan only 25 cases have been reported to date.
Recently we discovered a bile duct tumor, an adenomyomatous hyperplasia, by ERCP. A slight dilatation of the common bile duct was noted during abdominal ultrasonography. Based on the histopathologic findings of our biopsy specimen, the patient was spared surgery. This case shows that preoperative, morphologic diagnosis of benign bile duct tumors by the various imaging techniques of the biliary system alone remains difficult. An interventional approach by endoscopic examination of the biliary system and other methods such as PTCS with biopsy is important.
Furthermore, an aggressive attitude towards performing ERCP routinely even for slight dilatation of the bile duct found during abdominal ultrasonography will improve the rate of diagnosis of small tumors of the bile duct.

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Case 1 was a 53 year-old male admitted to our hospital for obstructive jaundice. ERCP showed stenosis of the common hepatic duct and a round calcification to the right of the stenosis. Histology revealed cystic formation consisting of fibrosis with calcification. It did not communicate with the biliary tree. Case 2 was a 56 year-old female who had died of liver cirrhosis. Autopsy revealed a 3×3 cm ball-shped cyst adjacent to the cystic duct. Histolocally, although the cyst was lined with bile duct epithelia, it did not communicate with the biliary tree.
We think that the calcification in case 1 might have been the result of regressive changes in a cyst such as that seen in case 2. Cysts near the common hepatic duct, but not communicating with the biliary tree, have not been previously reported and are probably very rare. We propose to call the cyst “extrahepatic solitary cyst derived from the biliary tree”.

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Following Irwin firstly reported the cancerous change of the congenital choledochal cyst in 1944, the disease has been the object of attention. Until now there are many case reports about the disease, the prognosis is still unsatisfactory because most cases are already past treatment. Then early diagnosis and treatment are eagerly desired. In this paper, we present a case report of early bile duct cancer associated with congenital choledochal cyst detected by ultrasonography and 10 case reports of early bile duct cancer in literature.
Our case underwent pancreatoduodenectomy and after 6 years and 3 months, he is safe and sound. Cases reported were among 18 to 50 years old and including our case,3 cases are male. All the cases but one complained abdominal pain, especially right hypochondralgy.4 cases were accompanied with obstructive jaundice on admission. Preoperatively,8 cases were diagnosed,4 cases were with ERCP and 4 cases were with ultrasonography. Pancreatoduodenectomy was performed in 4 cases while cystectomy were in 7 cases. And 4 cases were deceased (ave.25months after operation) while 7 cases are alive (ave.37 months after operation).7 cases were papillary adenocarcinoma,2 cases were tubullar adenocarcinoma, a case of papillotubullar adenocarcinoma and a case of adenosquamous carcinoma. In cases with congenital dilatation of biliary tracts, we must take care so as not to miss cancerous lesions in our image diagnosis. And ultrasonography is the most helpful in this purpose.

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A case of simultaneous double cancers of the common bile duct and the gallbladder was presented. Ultrasonogram and CT scan showed dilatation of the common bile duct and the intrahepatic biliary ducts. PTC showed V-shaped narrowing of the lower common bile duct. Preoperative diagnosis was carcinoma of the common bile duct. Pancreato-duodenectomy was carried out. A polypoid lesion was found at the neck of the gallbladder. Histological findings revealed poorly differentiated adenocarcinoma of the common bile duct, and papillary adenocarcinoma of the gallbladder. Only 16 cases of simultaneous double cancers of the common bile duct and the gallbladder have been reported in Japanese literature.

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